In Black Flies, his second novel, former paramedic Shannon Burke adheres to the old dictum of writing what he knows, and lays bare the virtually battlefront conditions facing ambulance crews who serve American ghettoes, in this case Harlem. Ollie Cross missed out on getting in to med school, so goes to work for the Paramedic Service instead, and gets assigned to one of the toughest possible beats. Working in Harlem is more than just a job – and Ollie Cross almost pays a very heavy price.

As a newbie, Cross is predictably the target of hazing from his colleagues – but this is more than just mucking around with his locker, their desire to break him in quickly reveals the very casual attitude that the paramedics have towards the value of human life, perhaps based on the similarly casual attitude that many occupants of Harlem have towards one another’s existence. The paramedic that Cross partners with most of the time, Rutkovsky, is willing to let him almost kill patients to demonstrate the right way to do things, while others are almost sociopathic in their outlook, verging on abusing the powers of life and death that society gives them. Only one medic, Verdis, lives in the community which the station serves, and he is reviled by some of his colleagues for caring too much – they think it compromises his efficiency.

It’s easy to see how the deprivation, suffering, pain and misery that the medics encounter could cause even the most compassionate person to develop a hard shell to cope – but Burke shows how most of the medics do far more than that, coming to see themselves as lone warriors of civilised values in the slums of America. It’s this attitude which leads to the pivotal episode of Black Flies, when Rutovsky makes a decision that is not his to make about the fate of an apparently dying child born to a crack-addicted mother. As his partner on the day, Cross is drawn in to the investigation, and when Rutovsky leaves, Cross lurches further in to the twisted worldview of his colleagues – estranged from his girlfriend, unable to relate to his family, the ambulance station is becoming his whole existence.

Black Flies is a story of the tension between compassion and contempt, and of the awful responsibility societies give to medical workers who have to contend with drug addiction, deprivation, violence, poverty and apathy, yet still expects them to value human life and do everything they can to preserve it. It’s a tale, ultimately, of redemption, of Ollie Cross picking a side, and picking right. Through the vivid depictions of the experiences of the paramedics, of their compassion and corruption, and their interactions, Shannon Burke has written a compelling novel that enhances our understanding of the faultlines in American society in the same way as David Simon has, while never losing sight of the need to tell a gripping story.

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